Patients who reach the chronic phase are either on long term parenteral nutrition or on a modified diet and nutritional supplements to avoid chronic nutritional deficiencies. Oral intake should be maintained to keep the residual bowel healthy and promote adaptation.
| Problem | Solution | |
| Generic problems | ||
| Maintain adequte nutrition | Education, monitor weight, set goals, keep enteral food and fluid intake records | |
| Prevent significant nutrient deficiencies | Monitor and measure at 3-6 monthly intervals essential fatty acids, vitamins and minerals (Mg, Mn, Zn, Ca). Prescribe oral supplements or add additional nutrients to infusate | |
| Minimize organ failure | Liver: oral intake, antioxidants, possibly choline. Kidney; hydrate, monitor output. Bone: supplemental Ca. Mg, vitamin D (include skin exposure to sun) | |
| Gastric Hypersecretion | Provide hydrogen ion blocking drugs | |
| Cholelithiasis | Cholecystectomy | |
| Patient with colon in continuity | ||
| Renal stones | Hydration; low oxylate diet | |
| Bacterial overgrowth, D-lacticacidosis | Reasonably rare in adults. Do not allow the patient to eat simple sugar. If D-lacticacidosis occurs, hydrate and give antibiotics; consider repopulating the gut with Lactobacillus | |
| Patient without colon | ||
| Chronic dehydration | Hydrate, monitor urinary output, give IV fluids (not TPN) if necessary | |
| Nutritional deficiencies | Monitor vitamins, minerals, and essential fatty acids levels every 6 months. Provide supplements; give IV nutrients if necessary | |
| Stomal problems | Symptomatic care | |